20050360A.pdfI
PERMIT
CITY OF EDMONDS ]NUMBER
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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NAME
ADDRESS
NAME
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ADDRESS
PERMIT EXPIRES
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SUITEIAPTO
PLAT NAMEISU B DIVISION NO.
LOT NO�
LID NO
LID FEE $
PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
RW Permit Required
Street Use Permit Rriquiied
EXISTING___ PROPOSED
inspection Roquito
Siatrwalk Required
REQUIRED DEDICATION FT
n argrotm
iring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 13 N013
REMARKS
OVWL4ER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
4 4
FIRE REVIEWED BY DATE
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0
CITY ZIP
TELEPHONE
VARIANCE OR CU
SHORELINE OR ADBI
I INSPEETION
REQ'D
YES 0 NOI
SEPA
COMPLETED I EXEMPT
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
CAP ZONE SIGN AREA HEIGHT
WAIVER 13 ROPOSED ALLOWED PROPOSED
STUDY 13
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PROPERTY TAXACCOUNT PARCEL NO.
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RESIDENTIAL
NEW PLUMBING I MECH
ADDITION. COMMERCIAL COMPLIANCE OR
MIXED USE CHANGE OF USE
REMODEL MULTIFAMILY Sl GN
LOT COVERAGE REQUIRED SETBACKS (FT.) I PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PAR
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AREA
PLANNING REVIEWED BY DATE
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GRADING FENCE
REPAIR CYDS x FT.)
REMARKS
OTHER.
DEMOLISH TANK
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CARPORT ROCKERY FIRE ALARM
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(TYPE OF USE, BUSIN OR ACTIVITY) EXPLAIN:
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TYFF OF CONSTRUCTION
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14UMBER
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STORIES
NUMBER OF
DWELLING
UNITS
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SPECIAL INSPECfION
RE OUIRED 13YES
CONSULTANT
OCCUPANT
LOAD
71
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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Description
FEE
Description
FEE
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Plan Check
st te Surcharge
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SOURCE
LOTSLOPE%
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VESTED DATE
I Building Permit
City Surcharge
HECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
2
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0.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSOR s
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
X EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.6
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building official or hisitter Deputy: and Foes are paid, and
receipt is acknowledged in space provided
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
'�M!,
FIC S SIG URE DATE
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(425)
771-0220 REL" A BY DAfE
LSIGNATUR (OwIWIE R AGENT):
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DATE SIGNED
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ATT NTION
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EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
ORIGINAL FILE YELLOW INSPECTOR
PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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